Ankle Osteoarthritis: Successful Completion of a Challenging Clinical Trial Comparing Surgical Treatments
Authors: Bruce Sangeorzan, Daniel Norvell, Jane Shofer
Journal: Annals of Internal Medicine (2022)

EditorialsDecember 2022Ankle Osteoarthritis: Successful Completion of a Challenging Clinical Trial Comparing Surgical TreatmentsBruce Sangeorzan, MD, Daniel Norvell, PhD, Jane Shofer, MSBruce Sangeorzan, MDUniversity of Washington, Seattle, WashingtonSearch for more papers by this author, Daniel Norvell, PhDVA Puget Sound Health Care System, Seattle, WashingtonSearch for more papers by this author, Jane Shofer, MSVA Puget Sound Health Care System, Seattle, WashingtonSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-3229 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In their article, Goldberg and colleagues (1) report a trial that was likely challenging to execute—a pragmatic, randomized, multicenter trial of surgical treatments for patients with end-stage ankle osteoarthritis. Although randomized trials are often considered the “gold standard” for determining treatment success by reducing known and unknown selection biases, the number of randomized trials of surgical interventions is limited. Standardizing surgical interventions, difficulties with blinding, ethical concerns, and surgeon and patient reluctance to participate are all substantial barriers to such trials (2, 3). Trials of surgical interventions can be especially difficult to execute when 2 treatments have characteristics that are ...References1. Goldberg AJ, Chowdhury K, Bordea E, et al; TARVA Study Group. Total ankle replacement versus arthrodesis for end-stage ankle osteoarthritis. A randomized controlled trial. Ann Intern Med. 2022;175:1648-57. doi:10.7326/M22-2058 LinkGoogle Scholar2. McLeod RS. Issues in surgical randomized controlled trials. World J Surg. 1999;23:1210-4. [PMID: 10552108] CrossrefMedlineGoogle Scholar3. Brewin CR, Bradley C. Patient preferences and randomised clinical trials. BMJ. 1989;299:313-5. [PMID: 2504416] CrossrefMedlineGoogle Scholar4. Agel J, Coetzee JC, Sangeorzan BJ, et al. Functional limitations of patients with end-stage ankle arthrosis. Foot Ankle Int. 2005;26:537-9. [PMID: 16045844] doi:10.1177/107110070502600707 CrossrefMedlineGoogle Scholar5. Glazebrook M, Daniels T, Younger A, et al. Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis. J Bone Joint Surg Am. 2008;90:499-505. [PMID: 18310699] doi:10.2106/JBJS.F.01299 CrossrefMedlineGoogle Scholar6. Vakhshori V, Sabour AF, Alluri RK, et al. Patient and practice trends in total ankle replacement and tibiotalar arthrodesis in the United States from 2007 to 2013. J Am Acad Orthop Surg. 2019;27:e77-84. [PMID: 30169446] doi:10.5435/JAAOS-D-17-00526 CrossrefMedlineGoogle Scholar7. Sangeorzan BJ, Ledoux WR, Shofer JB, et al. Comparing 4-year changes in patient-reported outcomes following ankle arthroplasty and arthrodesis. J Bone Joint Surg Am. 2021;103:869-78. [PMID: 33983146] doi:10.2106/JBJS.20.01357 CrossrefMedlineGoogle Scholar8. Daniels TR, Younger AS, Penner M, et al. Intermediate-term results of total ankle replacement and ankle arthrodesis: a COFAS multicenter study. J Bone Joint Surg Am. 2014;96:135-42. [PMID: 24430413] doi:10.2106/JBJS.L.01597 CrossrefMedlineGoogle Scholar9. Saltzman CL, Amendola A, Anderson R, et al. Surgeon training and complications in total ankle arthroplasty. Foot Ankle Int. 2003;24:514-8. [PMID: 12854675] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Washington, Seattle, WashingtonVA Puget Sound Health Care System, Seattle, WashingtonDisclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-3229.Corresponding Author: Bruce Sangeorzan, MD, Department of Orthopedics and Sports Medicine, University of Washington, 908 Jefferson, Seattle, WA 98014; e-mail, [email protected]washington.edu.This article was published at Annals.org on 15 November 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTotal Ankle Replacement Versus Arthrodesis for End-Stage Ankle Osteoarthritis Andrew J. Goldberg , Kashfia Chowdhury , Ekaterina Bordea , Iva Hauptmannova , James Blackstone , Deirdre Brooking , Elizabeth L. Deane , Stephen Bendall , Andrew Bing , Chris Blundell , Sunil Dhar , Andrew Molloy , Steve Milner , Mike Karski , Steve Hepple , Malik Siddique , David T. Loveday , Viren Mishra , Paul Cooke , Paul Halliwell , David Townshend , Simon S. Skene , Caroline J. Doré , and Metrics December 2022Volume 175, Issue 12Page: 1765-1766KeywordsAdverse eventsAnklesArthritisJoint replacement surgeryOrthopedicsOsteoarthritisRandomized trialsRheumatoid arthritisSurgery ePublished: 15 November 2022 Issue Published: December 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...